{
  "abstract": "Aim To improve ACP referral process for staff and patients receiving care at home.Background From FY 21/22 to FY 22/23, the Hospital Admission Risk Program (HARP) had a 69% increase in ACP referrals (49 to 83). Challenges were highlighted with the current referral process by staff and patients. Staff feedback revealed misunderstandings regarding ACP nurse’s role, referral procedures, and confusing concepts of goals of care versus ACP. Patient feedback identified confusion at the meaning and timing of referral; ACP home visits being rescheduled/cancelled due to a variety of reasons (e.g. too many appointments, needing more time to think, or feeling pressured to see an ACP nurse). It was evident a different approach was required from the feedback.Main Text Interdisciplinary evaluation of current process identified gaps and challenges from both staff and patient perspectives. Roles and responsibilities were clarified, processes developed with referrals, streamlined to designated ACP appointment times to allow for flexibility with patient needs, including being seen post discharge from HARP, education included ACP and goals of care. To assist the new processes, a new ACP referral form and ACP patient information pack were developed.The revised procedure enhanced referrals, patient uptake, care delivery diversity, and of the data analysed, all rated care very good. Results for FY 23/24, 98 referrals; 39 ACP documents drafted; 34 ACP discussions, 5 died and 20 other.Conclusion Together, we have reviewed, improved, and streamlined the delivery of ACP information and support for patients and staff. ACP guidelines by themselves are not always enough for staff working in complex care areas.Unique Contribution A collaborative process with patient and staff feedback has innovated ACP referral processes and practice. An ACP referral form must meet the needs of the referrer, patient and ACP staff. Collaboratively a new ACP referral form was developed which includes an option for staff to select the type of ACP nurse intervention (what we do/don’t do) further information of what ACP is, clinical triggers, and different options for modes of ACP support e.g. telehealth, email, post, in person or phone.Implications ACP guidelines may not suffice, and how they are translated into practice is key to ongoing improvements in policy and practice. This small research project, through collaboration, demonstrates how triangulating feedback from the consumer, referrer and referee, results in a patient centred outcome whilst improving professional practice.",
  "authors": [
    {
      "affiliations": [
        "Eastern Health, Box Hill, Australia"
      ],
      "name": "Samantha Brean"
    },
    {
      "affiliations": [
        "Eastern Health, Box Hill, Australia"
      ],
      "name": "Kelly Habjan"
    }
  ],
  "title": "78 What happens when you do a deep dive into current advance care planning practice (ACP)?",
  "uid": "99403e5b-962d-5a62-be85-317757f3d490"
}